Medicare AdvantagePrior AuthMedium impact
Trabectedin Products (Revised)
Humana·FL, KY, SC · Oncology, Pharmacy·Medicaid
Effective date
Jun 24, 2026
We identified it
Jun 25, 2026
Summary
Humana revised its Trabectedin Products prior authorization policy effective June 24, 2026, affecting coverage for Yondelis and Evdi (trabectedin intravenous solutions) across Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina. The policy maintains two distinct approval pathways: one for soft tissue sarcoma (with specific diagnosis requirements) and another for liposarcoma/leiomyosarcoma (requiring prior anthracycline therapy). Both pathways exclude members with disease progression on trabectedin products. Billing teams must ensure prior authorization is obtained before dispensing these drugs or claims will be denied.
Action Required
By June 24, 2026: Billing and pharmacy teams must implement prior authorization requirements for all Trabectedin products (Yondelis intravenous solution and Evdi intravenous solution) in the billing system for Medicare, Medicaid-Florida, Medicaid-Kentucky, and Medicaid-South Carolina plans. Update pharmacy management system to verify: (1) for soft tissue sarcoma cases—member has unresectable/progressive retroperitoneal/intraabdominal sarcoma, OR angiosarcoma/rhabdomyosarcoma, OR stage IV extremity/superficial trunk/head-neck sarcoma with disseminated metastases; (2) for liposarcoma/leiomyosarcoma cases—member has unresectable/metastatic disease AND prior anthracycline therapy. Configure system to deny claims where member has documented disease progression on trabectedin. Train pharmacy dispensers and billing staff on new criteria. Verify the online policy version before processing any Trabectedin claims to confirm you have the current version. Failure to obtain prior authorization will result in claim denials.